Prior authorization
Reduce the administrative friction in prior authorization
Rovicare helps organize authorization requests, supporting documents, exchanges, and status updates. Give teams greater visibility into what is complete, what is missing, and what needs attention.
- ProviderRequest submittedDone
- PlatformMissing imaging report flaggedAction
- ProviderRecord attachedDone
- Health planClinical reviewIn review
- Health planStatus responsePending
Elapsed: 1d 4h · The health plan makes the authorization decision.
Capabilities
- Request intake
- Document exchange
- Transaction validation
- Status tracking
- Turnaround monitoring
Outcomes we help you pursue
- Reduced authorization delays
- Lower administrative costs
- Fewer incomplete requests
- Better deadline oversight
- Regulatory readiness
Request to response workflow
Receive the request, validate required information, exchange supporting records, and track the response. Keep staff informed when additional information or follow-up is needed.
- Request submitted
- Missing record flagged
- Records exchanged
- Plan review
- Status response
Core capabilities
Support request intake, document exchange, transaction validation, status visibility, and turnaround monitoring within the confirmed implementation scope. The health plan retains responsibility for clinical review and authorization decisions.
- ProviderRequest submittedDone
- PlatformMissing imaging report flaggedAction
- ProviderRecord attachedDone
- Health planClinical reviewIn review
- Health planStatus responsePending
Elapsed: 1d 4h · The health plan makes the authorization decision.
System connections
Connect with the relevant payer and provider systems through supported interfaces. Agree on transaction formats, required fields, exception handling, and request-response responsibilities.
Regulatory context
Support preparation for applicable prior authorization requirements through the agreed workflows and interfaces. Discuss your affected populations, services, reporting needs, and implementation obligations with our team.
Turnaround reporting
Monitor elapsed time, outstanding information, overdue requests, and available disposition information. Administrative workflow performance is kept distinct from clinical decision-making.
Frequently asked questions
More answers on our FAQs page.
Bring your authorization workflow
Bring your authorization workflow and system requirements. We will review the supported scope and outline an implementation approach.